STAT Ethics Education with Steven Squires

In this episode Steven Squires describes an intervention into ethics education that has taken off!

Transcript

0:00

Welcome to this episode of Bioethics for the People, the most popular podcast on the planet according to Grandma Nancy.I'm joined by my Co host Doctor Tyler Gibb, who if he weren't here recording right now, would probably be golfing.And I'm joined by my Co host Doctor Devin Stahl, who dutifully completes the same 5 New York Times puzzles every day.

0:27

All right.Good morning, Tyler.Good morning.We have a special guest with us today who's going to tell us another success story.Are you tired of success stories yet?Or are you really like into success?You know what, I I really like the stories where things go off the rails and everything is a disaster.

0:48

The pandemic was my favorite part of my life so far because everything was falling off the rails.No, none of that is true.So yes, the success story series is going well, amazing stories from people.And what I really like is that some of them are completely out of left field, right?

1:06

Like the way that we think about clinical ethics is kind of being expanded through some of these stories, so.Absolutely.All right.So today we had a volunteer who comes out of the best state, or at least one of the biggest states.

1:25

Wait, so I don't know what state he's coming from.OK.Are you going to say Texas?I'm going to say.Texas.I'm going to say Texas.But I but I was born and raised partly in Michigan, so you know.I have a colleague who said that he would never go to war for the United States, but he would go to war for Michigan Sounds.

1:46

Like something a Texan would say about.Texas.Yeah, Yeah, it's exactly what I thought.Have have you ever seen the bumper sticker that says I'm smitten with the mitten?Yeah, Yep.There's a lot of cleverness that goes on in bumper stickers in this the shape of Michigan.So there.Is.By Peninsula and Proud is another one that I'm a big fan of.

2:04

Oh.Very nice, very good.OK, what are we talking about today?OK, so you're from Texas, apparently?Yes.In Texas now, right?All right.So, Steven, please introduce yourself.Hi everyone, My name is Steven Squires.I I've worked in Catholic healthcare for about 18 years as an ethicist, mostly system.

2:27

I have done a lot of regional work.I've been a local mission leader, which is the position that is about the identity of the institution in Catholic healthcare.So I've done that.So in other words, I've worked in a hospital.So I do know somewhat of how it goes, but I've done a lot of system ethics as well.

2:48

I've worked for Bonds Core, Mercy Health and Trinity Health based out of Michigan.Both are large coast coast Catholic healthcare systems.And I intern a little bit with Ascension Health.

3:05

And now I'm here at CHRISTUS Health based out of the Dallas Fort Worth area.And specifically, as you can see in back of me, I'm in Irving, which if you could see back far enough, Dallas is back there in the skyline.So as far as my background goes, I started as a bio premed major in college.

3:27

And you know, a few organic chemistry scores can dash your hopes of becoming a physician really quickly if you don't do well.Was that organic chemistry?Yes, yes, it was.Oh, Chem Yeah.

3:44

And I've heard this story before.I, I, I did not do well.So, but it does, it does get you thinking because you had a lot of physicians say at the time, well, you don't need to be a physician to make a difference in healthcare.

4:00

And some of them even referred to ethics by name, which got me kind of thinking my life took somewhat of a different track because I was also passionate about education.So I got a master's in education and I worked for a little while in colleges, particularly in residents life and admissions and things like that.

4:23

And then I decided to make a pivot to try and go into healthcare ethics.Got a master's at Loyola, found I couldn't get a job with the masters 'cause people would say, well, are you a doctor now?Are you a lawyer?No.Well, I don't know what we can do.

4:39

So I went ahead and got the doctorate and that was I think in 2012.So that's the short narrative.Married three kids, oldest is going to college this next year.

4:56

She's a senior in high school.So we're looking at that whole thing and he's looking, he's looking at Rice, which I suppose is good.I just cough a little bit when I see the tuition.But.Well, you got to spend money on something and it might as well.That's right.

5:13

Education of your kids.OK, all right, so good.So tell so now you're working at CHRISTUS in Dallas and tell us a little bit about CHRISTUS large small.It's I, I assume it's a Catholic organization and then what your role is within this, that system?

5:29

Yes.So Christus is AI would say medium to large Catholic healthcare system.There's over 40 hospitals just in the US alone.Recently we we merged and are, are are working with are the parent company of a new hospital in New Mexico and we also have hospitals in three other countries.

5:57

So we're not just US based, we're also in other countries.And I believe when you incorporate the presence of the other countries, that's what makes us so large.It's just you may not see it because the main three states were in our Texas, Louisiana and New Mexico.

6:19

We're a little bit into Arkansas.I don't know if there's any hospital there, but it's mainly the southern US.Gotcha.And your role is as the the system director of ethics or what?How do you describe your role?Yes, I'm vice president of ethics.

6:34

I'd say ultimately, you know, ethics is my responsibility throughout the system.You know, as, as I'm sure you know, and as a lot of ethics roles are, the majority of my time is spent either as a backup to the backup, to the backup of cases or working with policy.

6:56

But I find a large part of what I do, which is even later today, I'm doing an ethics console training for folks who are in, we have a hospital in Santa Fe.And so we've got a group of folks who want to be ethics consultants.

7:11

And so that's that's part of what I do is by we'll do a training there in person.I zoom in or I teams in and we'll do trainings about certain things.So we've got lots of education within the system.

7:27

Like we have ethics webinars, which I hope to get you 2 involved with as continuing education.We have modules that are online for whenever somebody becomes a new ethics program member, so whether a committee member or consultant.

7:49

And then we have a specialty consultation training, which is like today, and they get practice in doing cases.So we'll actually go through the method, go through some good interpersonal skills, and then we'll try out some cases.

8:05

Great.Yeah.So today though, you have a is it a case for us or a policy for us?Sort of what is your latest success or what came top of mind when we said, hey, we would love some success stories?So the, the thing that came top of mind for me is this in, in my mind, a success story can be a, a process that's shown demonstrated success.

8:33

And I think for me, one of the things that I've always scratched my head at in bioethics is how we're so inclusive of people from every single different field because it's kind of AI don't know if I want to say add on, but it's like you come with kind of whatever your base knowledge is.

8:54

And then ethics is something you get kind of a super specialty in.And one of the things I haven't seen a lot of I, I don't think is people out of education proper now.I'm not talking about professors.

9:09

You know, we, my guess is if you look at the Constitution of our, or the, the composition of the American Society for Bioethics and Humanities, we've got a lot of academics.What my question would be is do we have a lot of those academics coming with a background in education, you know, like an EDD or a PhD in education?

9:34

So I think part of my part of my question and my intrigue being somebody who has a degree in education is if this is the majority of what we do.And I know of at least one survey of ethicists that said, you know, what do you do mostly with your time?

9:54

And the ethicist said, by and large, in practice, it's education.And so my question is, why isn't there more method into how we do that?Because education has methods.

10:10

And I think maybe an underlying assumption is, well, yeah, but that's for that's for higher education.Those methods are for schools.Well, not necessarily.I mean, education is whatever setting that that takes place in, if there's an information exchange.

10:31

So born out of that, that's kind of the backdrop to me saying I would like to be a lot more intentional on how education works within our system.Definitely in general, I'm working on some things with the Catholic Health Association right now with education.

10:54

But also why, why are we so?So this is the second part of the genesis of it.Why are we so stuck in Especially Lunch and learns?We love a lunch and learn.Yeah, I, I think there's room for them.

11:13

And I, I've backtracked a lot because I've said, you know, gone are the days of lunch and learns and somebody corrected me to say, no, they still have a place.It seems to me that lunch and learn is like the the hour of the day where you're most likely to get the most amount of clinicians, although I don't know that that's actually true or false.

11:34

But and then it seems like ethics education, like a lot of education is like any place that we can get any kind of FaceTime, we're willing to take it, even if it's not a great educational environment, right.So I've been asked to to give a lecture at like 6 O clock in the morning to transplant surgeons.

11:51

And I was like, I don't even want to talk about ethics at 6:00 in the morning to people who are coming off of shift, right.So that makes a lot of sense to me.So does it start with a weary eye?Do whatever you want, you know?Yeah.Yeah.

12:06

No, I, I think you're right.I, I think now here are the things I think you're right in the sense of, well, where else are you going to get people?Are you going to get people on their lunch break before their day really starts?

12:23

So like prior to the shift or right at the beginning of the shift or at shift end?But where I'm going with this is there I have seen just in when I was, you know, much, much more day-to-day in hospitals when we would do something like a moral distress rounds, short center rounds, the the people who could come in the beginning.

12:55

And now this is quite a few years pre pandemic.I saw that drop off just because in a certain amount of time, nurses really only have 30 minutes for lunch.So you if you've got an hour program, they have to make accommodations to stay most of the time.

13:14

And now a lot of them can't.And then when you're in a classroom, like in a classroom that's in the hospital, that takes people off the floors to go to that classroom, which is generally fairly removed from where they are.

13:30

And then they have to get back.And so if you look at a nurse going to get lunch, you know that that takes, you know, sometimes 5 minutes in the line or in the lunchroom, you know, just to give that 5 minutes to walk over, you've already done away with 10 or 15 minutes.

13:49

So that really started captivating my attention is, yeah, lunch and learns will often get physicians who have kind of an hour they can juggle with.It's less and less.We get nurses sometimes we can get chaplains, we can get social workers.

14:07

But it kind of depends.So my big thing is if you're not doing it at lunch, if it's tough to do it sometimes at the beginning and the end of the shift, what are we looking at that we could do that's embedded in other things?

14:24

And Ty, I think you made the comment like, well, we'll take whatever we can get.Yeah, that's, that's true.But can we, can we take that and make it really good, sometimes even independent of setting And, and my contention is yes.

14:43

And so that's why I developed what I was proposing to talk about today, which is called stat ethics.Stat Ethics.OK.That's that's the name 'cause you know we don't have enough acronyms in healthcare.

15:03

Stat ethics stands for short, timely, applicable, and team based is.That what stat stands for when doctors?Yale Stat.No, yeah, we're.Probably.Not all right.

15:19

So stat ethics, OK.And this is an educational kind of format framework that you came up with, you and your team.I don't know who's involved, but to address this need of being able to give high quality ethics education in a situation where we don't have a lot of time or the setting maybe not within our control.

15:39

Yes.Correct.Great, So.It's largely based on adult learning styles because it's very much of A misnomer that because we're all, we're all with very educated people.I mean, most, most social workers have at least a master's.

15:57

Most, you know, us, we have, we have doctorates and MD's are doctors.And you know, we, we're dealing with people who have high levels of education for the most part, right?We sometimes, sometimes people have their bachelor's and things like that.

16:14

All fine.But I think the, the go to thought is that people generally learn like you do in a, in a classroom.And that's not necessarily true.

16:31

Adult learning theory and adult learning styles will tell us that adults can learn in very short bursts, like 10 minutes, 15 minutes.It has to be relevant, extremely relevant to what they do.

16:49

So don't my my theory is because we're in Catholic healthcare, Don't tell me what Aquinas said back in God knows when.Tell me how this is impacting my job now.And you would not believe the amount of times I hear.

17:08

Well, you know, Thomas Aquinas designed this.It was for when people were riding their horses and, you know, they, they trampled over other people.And whether it was double effect or whatever it went.And it's kind of like, yeah, you, you lost me already.I had a what?

17:24

So my mentor in clinical ethics, he always said that you have to, you have to be able to teach it to a trauma surgeon and not to be disrespectful to the trauma surgeons, but it doesn't matter what a client has said if you can't give practical advice to somebody who's in the trenches like a trauma surgeon.

17:41

And I think that's really the key skill of an excellent clinical ethicist is to be able to have that background knowledge of all the theory and, and the history of all of these different topics and concepts, but then translate it into something that a trauma surgeon, for example, can use.

17:58

So, so tell us more about this framework.Like what does it look like?A 10 to 15 minute model blitz of ethics education.So we have a little bit more as the background than just the meeting itself.So part of my theory too is we've also gotten lost generally that when we talk about ethics education, it never when you go to things like the Quinlan opinion or the President's Commission, when they talk about it, it never was the end goal of ethics was for our own education.

18:35

When I say our, I'm not talking ethicists, I'm talking Ethics Committee members or ethics consultants.They were never the end game.They were always the conduits.Then why is it then in it?

18:52

And, and by this point in my career, I've witnessed thousands.Because if, if you think about me going to 10 Ethics Committee meetings a month in, you know, virtually in different settings, I probably witnessed over 1000 Ethics Committee meetings.

19:10

Why is it most of the time when we talk about education, it's talking about educating ourselves.But then that never goes as were the conduits on to the final goal, which it always was.If you look at Quinlan and the the President's Commission, it always was that that's supposed to go out to the clinicians, to the associates, to the community.

19:37

And so how much are we not paying attention to that?It's kind of disturb us, but then it stops with us.It doesn't really get out anywhere else.And so that in fact is a huge bottleneck because there's people out there who are lay persons who probably don't have an ethics degree, that they've got an enormous amount of ethics knowledge that they could probably.

20:07

Teach fairly competently on a topic.And this is where the first point about stat ethics I want to get across is we're not asking people to be ethicists.What we're asking is to take a very finely tuned topic and to know the core issues about that topic.

20:31

I think anybody can do that.I mean, I wouldn't even ask somebody to wade into like NRP now or something like that.I what I do think we could do is, and this surfaced from, we had a particular case where it involved somebody who claimed to be the surrogate spokesperson for the children.

20:56

He was the oldest male, I think of three of three children.The other two were younger sisters.And then he was saying kind of interesting things to our staff members.And then the other thing that came up is he was trying to deny his mom from getting pain medicine, but he didn't have any good reason.

21:20

Like when we would ask, well, tell us about a conversation.Tell us about a time when you discussed that there was nothing.It was just, she shouldn't get this.And so I think going back to the topic that anybody should be able to say, for instance, you know, pain control is a basic right.

21:44

You know, unless there's an overriding conversation that, you know, for instance, believing in redemptive suffering, physical suffering or something like that, they're, they're in the absence of that, how can we go against somebody's fundamental right to pain control?

22:02

Now you can find out enough about say pain control and say the surrogacy priority order or whatever it might be to address that within a small time period.So that was kind of the first thing is we did when this launched and I'll, I'll, I'll describe it in just a second.

22:25

But when it launched, somebody wanted to do a hybrid between that and a lunch and learn.And so in essence, what they wanted was this is a 10 or 15 minute format that's within a meeting.So it's like a nursing huddle and we talked with the nurse supervisor to see if we can get 10 or 15 minutes in that time period.

22:46

Now this person wanted to do something that was like an abbreviated lunch and learn.So it was like a 30 minute lunch and learn or you know, 40 minute or something.And then that person who who is trying it out took a huge topic like surrogate decision making.

23:05

Not surprisingly, when that focus group got done, they wanted more.They didn't think it was enough time.But if you look at who it was, it was it was a small group of physicians and they had the time and they had a huge topic.

23:23

So they wanted to know more.They were curious.That's not what it was made for.So I'll I'll describe it very, very briefly.So the first thing is you need to identify a topic.And a lot of times that comes through a case where you feel like it just, it wasn't optimal in the way it happened.

23:47

Like we feel like there's some things we could learn from from that.The Catalyst case I mentioned for this first round of or the pilot, the second pilot of STAT was the case that I just mentioned.

24:05

And what we, what we want to do is identify that, then see where the questions were.Because in that case, the first questions were with the folks who dealt with the case.But then we heard others say, yeah, but that's interesting.

24:21

How was, you know, if somebody saying don't give pain meds, how should we respond?That's a good question.So then we thought, well, it's a broader group than just the folks who dealt with the case.We ask that somebody on the Ethics Committee, a point like a research and education person, have a point person for that particular topic.

24:47

That's the person who's going to begin the research for it.We have a form where our IT folks helped us design A form where the way it's done for quality control is the basic method of stat.

25:06

And this is very simple, three to five informational points, a very short case, three to five targeted questions about that case.And ideally that case should mimic, you know, the, the case that happened with, you know, altered details and everything, three to five questions about that case.

25:28

And then of course, that's going to generate discussion and then you leave with three to five resources.So it's kind of the rule of three to five, right?Yeah, the classic rule of three to five, which everyone has definitely heard of.That's right.That that might be on AT shirt soon.

25:47

A rule of three to five.OK, so a case based prompt or like Genesis and then some some questions, some resources for the people walk away with.And so what's been your experience utilizing this?Well, the, IT, it started, like I said, with that case and it was kind of perfect the way that one, the genesis of it, because if you were to take that and, and broaden it.

26:13

So one of the issues in that case was surrogate decision making.You've got the one guy claiming to speak for all the people that level, you know, it depends on what state you're in, whether it's the majority of adult children, whether it's an adult child, whatever it might be.

26:30

But that's, that's certainly something to look into.Whereas he claimed to be the person to speak.But is that really, is that really accurate?You know what, what do the other children think?And we found out later that they did want to be involved.

26:48

So even that claim of, you know, well, it's just me, you know, later on it seemed like it was the other family members want involvement.But if you were to take that and say, OK, we need to educate on surrogate decision making, you've now taken a topic that is a fairly focused topic and you've generalized it.

27:12

So if you're going to go with surrogate decision making, then you know, you get into, well, does this get into assessing capacity?Does it you know what, what are all the what about what's a reasonable amount of time?What's you know it, it can open up this huge thing.

27:30

Whereas we're really looking at what if one person on the level claims to speak for the whole level and you know, how do you how do you question that?Do you question that and how do you question it?That's what the issue is.

27:46

So don't don't generalize it, focus it.You know, so out of that case, I think there became like two or three stat ethics because one was on pain control and and pain control being a basic fundamental human right.

28:01

The other was about a decision, decision making level for surrogates and one person claiming to speak for everybody when you're not sure that's the case from the the hospital side.So the way we did it was we have a form that RIT set up where somebody on the local side types in the three to five points they think are the most important, gives a case, gives the three or five questions and the three or five resources.

28:34

Then what we do is we ask them to send the form to us because there's a, a part where they can put their their e-mail.What we ask is to put our e-mail us meaning ethics at the system level at Christa cells.

28:50

So in other words, having an ethicist kind of just give a second glance over what it is, right.And so then what we do is we take a look at that.Most of the time it's pretty good.They're just a little fine tuning things and we send it back to them and it arrives as this beautiful PDF because what it does is it has and I, I can send you a copy of the, the format is it has the topic and then it has the three to five points, the case, the questions, and then the resources.

29:28

So ideally what we'd like to do over time is to build up a library.Now it'll probably be a very large library because it's not just, you know, decision making capacity, it's in this instance and in this instance, But we're trying to build that up so that eventually somebody can just go to the library and say, oh, it's, it's already done.

29:53

I, I don't even have to do the little amount of of work involved to, you know, make one of these formats.So we send it back to them.They get, they get somebody like a supervisor who can give them time in the meeting format.

30:12

And for the most part, this is done at nursing huddles and they get that time and then they, they go and they discuss because other than the three to five points in the case, it quickly becomes very engaging because you ask these specific questions about the case.

30:34

And you know, that's, I mean, that's how it clinicians learn and adults learn is through cases that are really relevant.So it really is made as a discussion generator.And then, you know, when you close out at the end of all this takes is like 10 minutes.

30:54

When you close it out, that's when you leave people resources and they have to be either right there that you can give to them or publicly available because again, nurses and physicians and social workers and chaplains don't have access to the resources that the three of us might have as ethicists.

31:15

So it's got to be something that we've taken a look at and we said, yeah, this is, you know, that the, it's maybe something from core competencies or I, I don't know.But again, that's not, you know, you have to have the book to, to have it.

31:31

But maybe it's a a website that's a fairly respected source.A podcast, for example, an episode of a podcast.If only there were a good bioethics podcast that really was like educational and entertaining and like anybody could listen to.

31:48

Somebody should really make a podcast like that.I, I think there's a, there's a, there's a market for that.So there's.Good job with the upsell.I love that.That's great.A podcast on it, you know, something that people can listen to on their way home from work.

32:06

It's really accessible.So we did that and the initial results were phenomenal.And by that I mean we asked three questions about method.So it wasn't necessarily on the topic.

32:23

Now that we've ensured the method is good, now we're asking questions about the topic, but the method I asked three questions, is this method more convenient compared to traditional methods like a lunch and learn I?

32:41

We asked, is this more user friendly?Now that's an open term, but is this more user friendly to you than a traditional method like a lunch and learn in a classroom?And then is this more helpful to you?And what we got back was shocking because it was a 5 point Likert scale from status, much less in all of those factors to status much more on the far side.

33:13

Yeah, so tell me the the things you measured again.So usefulness.Convenience.It was convenience, user friendliness and helpfulness.We didn't we didn't define anything which it's open for interpretation, but when we got the results back on the Likert scale, it shocked even me 48 nurses.

33:37

So this we had in essence 3, three kind of little pilots, but when you conglomerate the scores, 48 nurses said, I think the convenience was 74% better than traditional methods.

33:54

The user friendliness I believe was 75% better and the helpfulness was 76% better.So basically, if somebody told you there's a method you can use for education that is nearly nearly 100% better than anything they've encountered, or a traditional method, my question is why wouldn't you use that?

34:20

I consider it at least.Yeah, 100% better.Well, OK, maybe I'll change the thing that I'm used to doing.Yeah, exactly.You know, I, I got that back.I'm like, wow, this, this is really cool because in essence, we were still reeling because that that first time where somebody wanted to do a hybrid approach.

34:42

I had to say, but that's not what it's made for.It's not made to be a hybrid of something else.It's made to be this.And we kind of went back and forth and then I thought, well, let's give it a try and see how it goes.Like I said, it was mostly to physicians and it was a very general topic and the timing was longer.

35:03

Will people left wanting more because they're in a classroom, They're thinking this wasn't an hour long.I have an hour long, I have questions.This whole topic wasn't explored.And so in my mind it made sense why they're like, no, I I don't want to go down less time.

35:23

I want more time.Well, if we had refined the topic more, if we had done it for nurses, if we had done it in the setting and you know, then I think you'd see a different result.And I would argue that's what we saw.

35:40

Yeah, it it seems so.A question strikes me that sometimes like the customer isn't always right.And what I mean by that is I don't know that the quality of education is directly tied to the satisfaction of the educated, you know, the person in the classroom.

35:58

So yeah, no good, really good point.Or that they would know best how to like improve that education if they were felt wanting, right?Like they can assess whether they enjoy the education, whether they felt like they learned something, whether it was relevant.And I think we should take their word for it, right?

36:14

Like, no, you just you really were educated and you didn't even realize it.It's probably not the best way to respond to that.But if you said, OK, you there was something lacking, how would you feel it?That's shouldn't be on the on the learner.That should be on the educator to think through.Like the learner might have some thoughts that you should listen to, but really it's the educator's job to figure out how to fill that.

36:34

And the intuition that you just needed more time might not actually be true.It might be that you needed more concentrated education.So it sounds like, yeah, that that that impulse that you initially had bore fruit that you either need to do a whole long lunch and learn or you need to do like these micro stat teachings.

36:52

And, and that's why I'm curious so on, on that front, three other Catholic healthcare systems have now picked this up and are trying different versions, trying their own version of it.And I'm really eager, I'd like to get maybe a call together so we can all talk and see how it's going and what the feedback is, because one system is trying it with their administrators.

37:17

And I'm wondering, well, how's that going to go?Because this really, I've even resisted saying, you know, is this something we should do for physicians?And maybe part of it is because of that when I scratch my head because of that first pilot with physicians saying I want more, this wasn't enough.

37:37

I, I guess where I'm going is this is shown the success with groups of nurses and nursing huddles.And so I, I think whether or not that works with physicians in the different setting, I, I don't know.

37:53

We certainly can try, but what seems to work is for nurses on this.I can even imagine this working for sometimes when I teach just in a undergraduate classroom, I like to open with like, hey, this thing happened or this thing could have, you know, usually I make it up like, what if you were the ethicist?

38:13

What would you do?And we can't spend 30 minutes on it because I need to get to the rest of the Lesson plan that day.I just want a little micro like, what's your impulse here?And how do you how would you justify that?And I need it to be quick because I need to get to the rest of it, the rest of the teaching for the day.But I'd love some like but but they always want to talk about that one thing for like an hour, so this would be a great way to do that too.

38:35

Yeah, I can see it in the medical education setting too, because one of the ways that I like to teach is split up people, you know, students into small groups and give them each an individual case.And then it's only like a, you know, maybe 15 minute and process of analysis.And then they come back and report out what it was.

38:52

And each one's a unique case.And so all of them get the whole students, all group get to the whole class gets to see or hear about 6 different cases for example.So seems like it could be very useful in that regard as well.Yeah.I think one of the things I've always been puzzled by is I, I don't know how familiar with it you are.

39:10

There was a model of ethics now probably 20 years ago called Next Generation Ethics, which was that, you know, it's supposed to be strategically proactive, integrated metrics driven, focused on mission and values.

39:26

Those were the four pillars of it.I think that, you know, this is something where, first of all, my view of how ethics committees go is that particular model started out of Ethics Committee meetings, becoming a philosopher's club.

39:51

And kind of like you were saying, everybody loves to talk about cases.I mean, there's in a sense, is there anything wrong with it?I don't know.But in my book, there are certainly a lot of other things we could be covering in a meeting other than rehashing a case that, when you think about it, if the case has already happened, past tense.

40:15

Why are we going over everything over and over?I mean, for people who are familiar with what clinical meetings are, they're very short into the point.It's like a, it's like a military briefing.And I kind of get to, but if we've talked about this for an hour a case, it's already done.

40:39

And we didn't talk policy and we didn't talk education and we didn't talk about the patterns that are merging within the system.We didn't talk about community relations.But what's the outcome to that case?It's already done.

40:56

So I I don't other than for our own awareness and kind of, you know, talking about and maybe making things a little better for the next time.But I think that's where the next generation method started with frustration of but aren't we missing a whole bunch of things?

41:13

If if we become kind of a philosopher's club and let's face it, most of us, us being not Ephesus being more like doctors and nurses and social workers, if most folks that isn't really what they do.

41:31

Again, the question comes back to how much are we serving others versus ourselves in in that case.And I'm not trying to be mean, I'm just trying to be realistic in in that.So what I think is interesting too is on the case side, when you go to the meeting, the cases should be really minimal.

41:54

You know what went well, like a delta, You know what went well, what didn't, what can we change that type of deal.The reason I'm mentioning that is because I also resist taking meeting time necessarily to do a lot of education for ourselves because that can be done in other settings, like a podcast in a car.

42:19

Like a podcast in a car.Podcast in a car and I know people who do that, so they'll they'll, I mean, they'll listen to a pod, they'll listen to an ethics podcast in the car.So have that for your continuing education, offer your education for ethics program members at a different time, either a podcast they can upload or we do half an hour kind of quick ethics lunch and learns for all ethics program member continuing education.

42:51

But the reason I say that is then at the meeting, it became it can become more operational to OK, we had this case, here's what's happening culturally.And so here's where we might need to do a stat ethics education.

43:09

How are we, you know, does anybody want to be point even now, you know, as a group, let's think of what are the biggest three to five things we want to get across?And then how can we alter the case so that it's more anonymous?You can actually use it in an operational sense during Ethics Committee meeting time if you carve out the space for it.

43:33

So that's that's kind of why I got into all that other stuff is it's like we, we should be, we really should look to clinicians as a model on how to run a very operationally efficient mission.And we need to kind of speed up the pace or we're going to lose people.

43:52

Because whether we realize it or not, I would say our clinicians operate with like military, like efficiency in what they do.So that that's a lot of it, yeah.Yeah, it sounds like almost you're flipping the classroom.

44:09

Use a flipped classroom model for your Ethics Committee education, giving them the the meat of it in the background.And then when they get to the meeting, they can actually apply it, which is, you know, aligned with a lot of adult education theory as well.So good on you, as they say down under.Yeah, I love this, Steven.

44:25

I think that's a great intervention.It sounds like the results were really positive and you were and are a success.Good.Very good.Well, the most powerful motivator I've ever heard is no, you can't do this.

44:42

And when I first mentioned the idea, there was at least one colleague.I think there might have been two.Or like, you can't do education that amount of time and a subject.And I'm like now, because you said that I'm going to make this hard.Yeah, I see your personality type there.

45:00

Yeah, Yeah.Well, it's a personality type, but it's also reality, right?Like I'm thinking then when this person said that, I'm thinking you know nothing about adult learning or at least you don't seem to demonstrate anything you know about adult learning.

45:17

So I think for me it's what's the kind of new generation or next way that we can work with our clinicians on education.Great.Well, I think we have to leave it there, Steven, but we appreciate your your insights.

45:35

This this new model you've described sounds like it's going really well.So yeah, keep up the good work and we'll look to follow what you guys are doing down there in Texas.Sounds great.Thanks, Steven.OK.Thank you.Bye.

45:51

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46:13

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